Knee manipulation

You have had your total knee replacement, but now you have less range of motion than you had before surgery. Your knee is stiff and swollen, you cannot bend it the way you used to and climbing stairs is impossible. It takes between 3 to 6 months to regain full range of motion, however if after 2 to 4 weeks of post surgery rehab you cannot bend your knee to 90 degrees or straighten it, then you may require knee manipulation.

In some patients, having a stiff knee may be due to decreased range of motion before surgery. Difficulty with pain management may also make it difficult to mobilise the new joint. Scar tissue formation is another culprit that may lead to knee stiffness and decreased range of motion. In some cases the doctor may have to remove the adhesions to allow for proper movement. Errors in positioning the implants can also lead to difficulty bending and straightening the knee.

Physiotherapy helps to achieve normal range of motion. Early mobilisation of the knee will involve the use of a continuous passive motion machine which passively moves the knee joint to restore flexibility. In addition, knee manipulation may be performed by the surgeon using anaesthesia. This procedure is indicated when x-ray shows that the implants were properly positioned and the person had normal range of motion before surgery, but active range of motion remains less than 90 degrees despite aggressive physiotherapy.

Before performing knee manipulation, the surgeon assesses the range of motion and how much further the knee can bend under anaesthesia. Then, with the leg supported by two persons, a steady progressive force is applied until the adhesions give way. Care must be taken to avoid breaking the bone around the implant. The goal is to bend the knee to 110 degrees to allow you to perform most activities of daily living.

Following the procedure, a CPM machine is used for twenty four hours, after which physiotherapy may begin. It is important that you cooperate with your physiotherapist during this time in order to maintain the flexibility you achieved during the manipulation and to strengthen the muscles around the knee.

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